Romina Viorela Murvai

Background and Objectives: The COVID-19 pandemic profoundly disrupted maternal and newborn healthcare worldwide, necessitating rapid reorganization of healthcare services while maintaining essential care. Evidence from Central, Eastern and Southeastern Europe (CESEE) remains fragmented despite the region’s heterogeneous healthcare systems and variable pandemic responses. This scoping review synthesized the available evidence on maternal and newborn healthcare delivery during the COVID-19 pandemic and proposes a Maternal and Newborn Healthcare Resilience Framework (MNRF) to integrate the findings across key domains of healthcare resilience. Materials and Methods: PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched, with Google Scholar used as a supplementary search source. Eligible publications were published between 1 January 2020 and 31 May 2026. Evidence was synthesized across four predefined MNRF domains: access and continuity of care, healthcare organization and system capacity, quality and family-centered care, and maternal, perinatal, and neonatal outcomes. Results: Twelve publications met the inclusion criteria; several represented analyses derived from shared or partially overlapping datasets, particularly the multinational IMAgiNE EURO project. Across CESEE countries with available evidence, the pandemic disrupted access to antenatal services, accelerated the implementation of telemedicine, and prompted extensive reorganization of maternity and neonatal care. Family-centered practices, including birth companionship, skin-to-skin contact, breastfeeding support, and shared decision-making, were consistently affected. Maternal, perinatal, and neonatal outcomes showed no consistent regional pattern of deterioration in the included evidence; however, data were limited and heterogeneous, and localized increases in stillbirths and changes in neonatal healthcare utilization were reported. Conclusions: The COVID-19 pandemic exposed important vulnerabilities and prompted substantial adaptations in maternal and newborn healthcare delivery in the represented CESEE settings. The MNRF provides a structured, hypothesis-generating conceptual model for organizing these experiences and identifying priorities for preparedness and future research.

Background: Preeclampsia is a heterogeneous multisystem disorder characterized by endothelial dysfunction and angiogenic imbalance. While the sFlt-1/PlGF ratio is widely used for diagnostic purposes, its role in defining biological phenotypes of preeclampsia remains insufficiently explored. This study aimed to investigate whether angiogenic imbalance is associated with distinct multisystem phenotypes of preeclampsia and with perinatal outcomes. Methods: We conducted a retrospective cohort study including 320 pregnant women, of whom 68 were diagnosed with preeclampsia. Multisystem phenotypes were defined using laboratory markers reflecting renal, hepatic, and hematologic involvement. The sFlt-1/PlGF ratio was compared across phenotypes. Associations with gestational age at delivery, birth weight, Apgar score, and neonatal intensive care unit (NICU) admission were evaluated. Receiver operating characteristic (ROC) analysis assessed the discriminatory performance of the sFlt-1/PlGF ratio for identifying the renal-dominant phenotype. Results: The mean sFlt-1/PlGF ratio was higher in preeclampsia compared to normotensive pregnancies (58.5 ± 20.3 vs. 34.6 ± 15.9). Within preeclampsia, the renal-dominant phenotype showed the highest ratio (66.0 ± 22.5), followed by hepatic (55.9 ± 18.2) and hematologic phenotypes (52.0 ± 16.8). The renal phenotype was associated with earlier delivery (34.6 weeks), lower birth weight (2196 g), higher NICU admission (10.7%), and lower Apgar scores. The sFlt-1/PlGF ratio demonstrated moderate discrimination for the renal phenotype (AUC = 0.69). Conclusions: Angiogenic imbalance varies across multisystem phenotypes of preeclampsia and is associated with meaningful perinatal differences. The sFlt-1/PlGF ratio may contribute to phenotype-based risk stratification, supporting a move toward precision obstetrics. Prospective studies are needed to validate phenotype-oriented classification models.

Background: Preeclampsia is a major cause of maternal and perinatal morbidity, characterized by placental dysfunction and angiogenic imbalance. The soluble fms-like tyrosine kinase-1-to-placental growth factor (sFlt-1/PlGF) ratio has emerged as a promising biomarker for preeclampsia; however, its prognostic value for maternal and neonatal outcomes remains incompletely defined. Methods: This retrospective cohort study included 320 pregnant women, of whom 68 were diagnosed with preeclampsia, and 252 served as non-preeclamptic controls. Maternal serum sFlt-1 and PlGF levels were measured after 20 weeks of gestation at the time of clinical evaluation for suspected hypertensive disorders of pregnancy. Group comparisons, effect size analysis, receiver operating characteristic (ROC) curve analysis, and multivariable regression models were used to assess diagnostic performance and associations with maternal and neonatal outcomes. Results: The sFlt-1/PlGF ratio was significantly higher in women with preeclampsia compared with non-preeclamptic pregnancies (58.5 ± 17.3 vs. 34.6 ± 19.0; p < 0.001; Cohen’s d = 1.31). ROC analysis demonstrated good discriminative ability for preeclampsia (AUC = 0.81, 95% CI: 0.75–0.87), with a high negative predictive value. Increasing sFlt-1/PlGF values were independently associated with earlier gestational age at delivery, lower birth weight, reduced Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score, and a higher likelihood of neonatal intensive care unit admission. Conclusions: The sFlt-1/PlGF ratio is a robust biomarker for preeclampsia, providing both diagnostic discrimination and prognostic information regarding maternal and neonatal outcomes. Its integration into clinical practice may support clinical risk awareness when interpreted in the context of standard clinical evaluation and support informed decision-making in pregnancies with suspected or confirmed preeclampsia.